Daily PrEP is suitable for all people who are at risk of HIV. Daily PrEP is the only PrEP regimen that is recommended for cis-gender and transgender women, for transgender men who have vaginal sex, for men who have anal or vaginal sex with women, PWID and for people with chronic hepatitis B (6).
Only cis-gender MSM have a choice between daily and on-demand† PrEP. In this setting, daily PrEP would be preferential for those MSM who cannot predict when sex will occur, who cannot delay sex for more than 2 hours and for those whose potential exposure to HIV occurs more than twice a week. Daily PrEP is the only suitable regimen for cis-gender MSM with chronic hepatitis B infection to maintain virological suppression, prevent drug resistance and hepatitis flares.
On-demand† PrEP would be suitable for those MSM whose preference is for the on-demand† regimen, who have sex less than twice a week, and who can plan ahead for sex at least 2 hours in advance. Other reasons that MSM may choose or merit on-demand† PrEP include side-effects from daily PrEP, poor kidney function or financial constraints.
The ASHM PrEP Guidelines Panel will continue to monitor HIV incidence in MSM using on-demand† PrEP, including those who use on-demand†PrEP less than fortnightly (11).
Summary of when to recommend daily and on-demand†PrEP
Based on the evidence, the ASHM PrEP Guidelines Panel continues to recommend daily TD*/FTC dosing for all populations suitable for PrEP. The ASHM PrEP Guidelines Panel recommends that on-demand† PrEP should be offered to cis-gender MSM. For cis-gender MSM, on-demand† PrEP should be offered when this preference is expressed, when the person has at-risk sex less than twice a week, when the at-risk sex is unpredictable, and when sex can be delayed for 2 hours. Daily PrEP is the only suitable regimen for cis-gender MSM with chronic hepatitis B infection.
† The Therapeutic Goods Administration (TGA) has not approved this regimen in Australia.